Sub-Saharan Africa: Healthcare

Lord Giddens Excerpts

Thursday 16th July 2015 Grand Committee

[Lord Giddens (Lab)]

My Lords, I congratulate my noble friend Lord Boateng on having secured this debate and introduced it so effectively. I hope that I am not the only person present who feels distressed that there are so few contributors, as the Ebola epidemic still causes devastation across west Africa. As I discussed in a previous debate, the social and economic impact of the Ebola epidemic in Sierra Leone has been particularly severe. The country went from having one of the fastest-growing economies in the world to one that has shrunk by fully 25% of GDP. Rebuilding the healthcare system will require a great deal of direct financial aid, which can come only from the international community. In turn, a viable healthcare system cannot be built unless there is a sustained economic recovery.

The backdrop to this is not encouraging. We live in the most interdependent world ever. There was a point when people in many countries were perturbed about the Ebola outbreak. However, this is not a world that has effective global governance; the United Nations is probably at its weakest ever. In many fields one finds that pledges are made but no money is forthcoming. My great worry is that this will also be true in the case of the Ebola outbreak.

A meeting of the UN last week saw pledges of $3.2 billion to help the recovery in the three countries most directly affected by the epidemic. As the Minister will remember, I mentioned in a previous debate that the World Bank has pledged $1.62 billion. I ask, again, whether she knows whether those figures have any reality. To me, as someone who works on climate change, they sound eerily like the $100 billion a year that developed countries have pledged to the poorer counties of the world to help alleviate the effects of climate change. Virtually none of money has ever become real; this must not happen in the case of the Ebola epidemic.

Zoonotic diseases are on the increase in Africa and are in fact connected with climate change—the chief connection is deforestation. They can cause havoc and have global implications. As the noble Baroness, Lady Walmsley, mentioned, Ebola could have become a worldwide pandemic if it had happened to be an airborne virus. In Africa, the impact of the Ebola epidemic overlaps heavily with diseases that are already putting great strain on existing healthcare systems. Sub-Saharan Africa suffers from the crippling effects of HIV/AIDS, malaria and tuberculosis. Over three-quarters of total malaria cases across the world are located in Africa and over 90% of malaria deaths occur in that continent. More than 20 million Africans are living with HIV/AIDS, a staggering number, although, it has to be said, about 70% are now obtaining antiretroviral treatment.

While most attention has naturally been concentrated on the three countries that have borne the brunt of the Ebola epidemic, states not directly involved in the epidemic have also been deeply affected, again with major economic consequences. For example, a recent survey of holiday operators found a decline of up to 70% in bookings, primarily because of fear of Ebola, including for countries quite remote from those directly affected, such as Kenya, South Africa and Mozambique. The overall knock-on effect economically, morally and socially across large areas of Africa has therefore been profound—and continues to be so.

If the Minister can overcome her terrible malady, I have three further questions to ask her. First, everyone now accepts that the response of the international community to the Ebola outbreak—and especially that of the UN agencies—was too slow and fragmented. What are the main reforms that the Government would like to see put in place before the next potential global pandemic? We are in a situation where everybody is drawing lessons but the theorem that I mentioned at the beginning applies. These are mostly abstract; it is hard to see where the beef is—where the substance is. This is really dangerous, I think, for possible future pandemics. Any information that the Minister has on that point would be valuable. What would be the best reforms to produce a more effective response on the part of the international community to the next global pandemic? Any such pandemic will likely be zoonotic, as I have mentioned, but could be much more lethal.

Secondly, there has to be a step change—as I think the noble Baroness, Lady Walmsley, mentioned—in the training of medical personnel. When the epidemic started, Sierra Leone had only one doctor for every 70,000 people; compare that to Britain, where there is one doctor for every 360 people—and now they are going to have to work seven days a week. How could this process happen quickly? I cannot see any way except by the sustained involvement, again, of the international community, which means medical personnel being in the affected countries and surrounding countries for a sustained period—at least five years further. What contribution will the UK make to that and has it got that kind of timeframe? To me it seems absolutely necessary.

Thirdly, however, I think that there is a theorem of hope around. This is a period of fundamental innovation in medicine, largely because of the digital revolution. For the first time ever in human history, I think, cutting-edge technology is going directly to the poorer countries of the world. A major example is mobile phones and smartphones. The case of Nigeria, which my noble friend Lord Boateng quoted, is really interesting because Nigeria contained Ebola partly by means of text messages sent directly to millions of citizens daily to alert them to the actions needed so that the disease did not spread. This would not have been possible even 10 years ago.

We know that in Africa it has been possible to produce a kind of leapfrog effect with mobile phones—that is, African countries have gone directly to a phone system without having the stage of fixed telephone lines. It is possible that the same thing could happen with medical treatment if there is an effective response by the international community. In other words, that community should continue to bring front-line treatments, even experimental treatments that have not been fully tested, to west Africa and other parts of the continent potentially affected. It is at least conceivable that there could be a kind of breakthrough effect, because it is not just a matter of training medical personnel. If we could bring medical innovation on a large scale on that kind of model directly to poorer countries in Africa, it could be transformative in its potential impact.